From the ancient Greek for equality in freedom of speech; an eclectic mix of thoughts, large and small

Low-hanging ulcers

Wednesday, December 12th, 2012

If we look at cases where an innovation or discovery was possible long before it was developed, Gregory Cochran says, we might find patterns to help us detect low-hanging fruit dangling in front of us today:

We know that gastric and duodenal ulcers, and most cases of stomach cancer, are caused by an infectious organism, Helicobacter pylori. It apparently causes amnesia as well. This organism was first seen in 1875. Nobody paid any attention.

Letulle showed that it induced gastritis in guinea pigs, 1888. Walery Jaworski rediscovered it in 1889, and suspected that it might cause gastric disease. Nobody paid any attention. Krienitz associated it with gastric cancer in 1906. Who cares?

Around 1940, some American researchers rediscovered it, found it more common in ulcerated stomachs, and published their results. Some of them thought that this might be the cause of ulcers — but Palmer, a famous pathologist, couldn’t find it when he looked in the early 50s, so it officially disappeared again. He had used the wrong stain. John Lykoudis, a Greek country doctor noticed that a heavy dose of antibiotics coincided with his ulcer’s disappearance, and started treating patients with antibiotics — successfully. He tried to interest pharmaceutical companies — wrote to Geigy, Hoechst, Bayer, etc. No joy. JAMA rejected his article. The local medical society referred him for disciplinary action and fined him

The Chinese noticed that antibiotics could cure ulcers in the early 70s, but they were Commies, so it didn’t count.

Think about it: peptic and duodenal ulcer were fairly common, and so were effective antibiotics, starting in the mid-40s. Every internist in the world — every surgeon — every GP was accidentally curing ulcers — not just one or twice, but again and again. For decades. Almost none of them noticed it, even though it was happening over and over, right in front of their eyes. Those who did notice were ignored until the mid-80s, when Robin Warren and Barry Marshall finally made the discovery stick. Even then, it took something like 10 years for antibiotic treatment of ulcers to become common, even though it was cheap and effective. Or perhaps because it was cheap and effective.

This illustrates an important point: doctors are lousy scientists, lousy researchers. They’re memorizers, not puzzle solvers. Considering that Western medicine was an ineffective pseudoscience — actually, closer to a malignant pseudoscience — for its first two thousand years, we shouldn’t be surprised. Since we’re looking for low-hanging fruit, this is good news. It means that the great discoveries in medicine are probably not mined out. From our point of view, past incompetence predicts future progress. The worse, the better!

“Modern attempts to eradicate h pylori use “triple therapy” of two different antibiotics plus a PPI, taken simultaneously, all for a unusually long period of time (one to two weeks). If you just give a patient a random antibiotic for some other disease, that’s not going to produce astounding results: you need the PPI to alter the transport of the antibiotic and prevent it from getting immediately broken down in the acidic environment of the stomach, and you need both antibiotics in case the bacteria develop resistance to one. Although some doctors probably got lucky and eliminated h pylori by chance, it’s not like every time anyone took an antibiotic it was curing their stomach ulcers and no one noticed.”

“Why else didn’t people catch onto h pylori’s role in stomach ulcers quicker? Well, at least 80% of people with h pylori don’t have ulcers or any symptoms whatsoever, and 20% of people with ulcers don’t have h pylori, so that’s going to confuse people. Second, h pylori is hard to stain and very hard to culture, so all you have are these Bigfoot-esque rumors of “I saw this bacterium in the stomach…I think…no, I don’t have any to show you.” A bunch of studies looked for bacteria in the stomach and find none, because of previously mentioned staining and culturing problems. And whenever people tried treating ulcers with antibiotics – and they did do the studies – they get equivocal results because they weren’t using the exact right drug combo to hit h pylori and keep it gone. The first person to successfully culture h pylori was the guy who won the Nobel Prize for discovering it.”

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